30307 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO BUILDING-ELRCTRICAL PERMITNO IK /( 7
BUILDING DIVISION APPLICATIONIPERMIT PLUMBING MECHANICAL 3030 1
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPLICATIONSUHML`I'ALDAT
0 5 , as}t1, I S D '270 q(D
OWNERS NAME: PHONE CO RACIYlR;S NAME: LIC NO:
�1 � NIC CONTROL♦
HI
I�ARCTECDPNGINEER: I` WCNO: ADDRESS: ❑
CONTACT. PHONE: BUILDING PERMIT INFO
['q q,7�(J 4 ❑ ConsW and Fcea Paid by Applicant(Initial) � ELECT PLUMB MCH
^SD b ❑ ❑ ❑
LmFNSEDCONltACnUR'SDBCno,of CON QTY ELECTRIC PERMIT NEE
1 Mmny )a that 1 ran fcrnud umber pavidnnr of Chapter 9(mnmmencmR JOB DESCRIPTION
{Q00 wimh samiarmle ec DvhiooJof Jet Business sari Rvfnxial Code.W mYlicauc is RESIDENTIAL
F In full fume erd eRm, PERMIT ISSUANCE
FC. Liwtu Claes lie.M D SPI)wL ❑KITCHEN REMODEL.
HzW Das Contractor APPLIANCES-RESIDESITIAI, ❑ADDITION ❑PLUMBING RE-PIPE
on ARCHITECTS DECLARATION PANELS ❑MULTI-UNIT ❑STRUCTURAL
z,Fp tri 7J. I wukrnawl my plans shall M stud es publm re...rds MODIFICATION
OZ-0 UPTONOAMPS EINTERIOR IMNEY REPAIR
Pay�LAt"q Umrsm[Pmfessionel 1(11-IfgOAMPS IMPROVEMENT
g SE��
OWNER-BUILDERDECTAHATION OVER 1"AMPS D BATH RFAODEIJREPAIR DDEMOLIIION
CC 1 thereby urfrm ma I.".Bump frim tic Contractors LiAny c tyLaos,far the
LLO d V bllowlo.rens,"I.Secrt to)0315.Busine.l.N Nofuliam Code:Any city mrnuuy SIGNS ELECTRICAL ❑OTHER
0�m¢' which,it,ma a pnmim re airs,f L elmtt,improve,den—it,w e a tiir eal sarumaon
ent
t�hJ prio the 4lixwencc,slat rtyuirtr Je uppliant fire Cosm,hprmn mfka•Lw(ChWem SPECIALCIRCU C.
W2� durmannattnud pavvm"the no Divimuu oftCmtnuSmSLianu luwlCTuptt9
ty tYO�a fcammvein.with Saurian]Oro)Wllinlion 3uf mhe Busircss.nd Pmfcugria Coca)or 'LETUP.MLTER IT NST. COMMERCIAL:
d e LL that ha ix exempt mercfnxn and the Iasis for the allced exempla.Any violation of D NEW BIAG/ADDITION ❑DEMOLITION
Mco Seemor70313 by any applicant her. nut,abjecis th.applicant to a civil Penalty of POWER DE C ❑TENANT ❑FOODSERVICE
tont more Jun five hundred dal Wa(SSoo).
q < Dl,e.uwmafinepopmy,wmyemployew with wayw av NcirsMecnmpevatiun, SWIFIMING POOL ELDCTR IMPROVEMENT
K2K2 will da tiewml,arW the,Wucturt a must intcndd".Rand r«sale(See 7u_Bwitce. [I OTHER
W and Prefi.sions Code:The Cm.W,license"w coca not apply to ao mw M OITfI.EIS-SWITCHES-Fl
a 3 propcnty who buildpwnmt
s or imm th ,and who docea
s ch workw
himself ea tlugh
hin own cmplayecv,pmvid:d tart such improvements ane not inamed orofferal for NEW RESIDENTIAL ELECT? SQ FT '
.k.If.Wwever,the Wildingen impavrnent is sold wiminooeyearofcanpMian.de My FT.FLOOR AREA IvsQ.FT.�
.builder will navemha buden ofpovin,that he did m WiM nr in,ove for el
(]L n
.,of the pov stay.em.xclusively canscJmy with licen i cant..to TOTAL,
caemoct the Project(Sec.76H,Business end Profeavea Code:)The Contmorn L- J114 3
e r UwdrcsmvapNytoanowrarof Mo ftyW )hiWd improv«Rwvcun.md QTY. PLUMBING PERMIT FEE O
whornnmacu for such projeeu stimacommscm%)licem dpotsumu tothe Covbei C//r f 799
O 1 em exempt umber Sec. ,B&P C for this noun PERMIT ISSUANCE
L
rfl)I•..
Owner qtr ALTER-DRAIN&VENT-WATER(PA) VALUATION
• WORKER'S COMPENSATION DECLARATION BACK PLOW I'ROMCU DEVICE
1 htteby at fn or,ander Penaty of perjury nae U me left..in,deelumt earn:
I have uM vill meinteintrCmi castifCaeaeon.scif.nefm Wmtr lCompco DRAINS-FLOOR.ROOF,AREA,COND. STORIES TYPECONSTRUCTIOI,
..tion,.a preavidN for by Section 3'n AT of tM IeMn Code,for tk perf.cir,of mfr
work fm which this permit i,his ml. FIX'I'URFS-PER TRAP
❑ 1 have end will malmaor Worker's Conrromemian bruance,u required by Section
3) .the l Co,e.formhc performwaof me work forwdtich this pmnm is isnd. GAS-E1.SYSTEM INC.4 OUTLETS
Fly Wufclr n prn mmc MPoli< OCC.GROUP APN
Policy num r GAS-EA.SYSr'EM-OVER4(EA)
Cormier on a °"MPolicyON FROM
CERTI CATEOFEXFMPIII NFROM N' KERS'
COMPENSATION INSURANCE GRFASFIINDU.STRL WASTE INTERCEPTOR BUILDING DIVISION FEES
1'misunix aced rotWmrmputW ifthepermit isfmorc hundmNahnlWa(f HO) GRFASETRAP
w beau) PIANCHECK PI:E
Icrnify Jut in ma erba .neeuftba weak for which thisperran is irmed,I"I SEWER-SANITARY-STORM HA.LUT FT.
of
employ any ,"in any mannm,wr f hccn ecu,me Workery Compero ENERGY FEB
OZ of aluwr Mlllilomia.IfJ: WATER HEATER WNENfyELECTR
zO APpicen ; GRADING FEE
h N.1 A .I n er making""C""Late of facmpion,yuu duan, WgJEy SYSTIAVTREATING
h bmome lubjam m me Works,Ccmycneatia pmvieiona of the Labor Coils,yon matt SOILS FEE
farmwimmaomply edea each rovivimis Prmut shell bcdcaml revelom. WATER SERVICE
0
uz CONSTRUCTION is.c.m.
LENDING AGENCY NEW RISIDFNTIAL PLMB. SQ,FT. PAID
I hvebyaff Jvrmil ns.comSte.N)kndiv...yeayfnrJc perfmreacof Date RacipY
� � tk work for which this perntim is issuM(Sas A5],Civ.Cd
U lenders Name TOTAL:
LW lenaera Adlrtas TOTAL
ly, 1 certify Jout 1 hie read Ni.appliwim and sous bu the.Mvc informed.i. BUILDING FPJ3
N "rear.I egrcc w",tipsy aim all city and carry rMlnatccs end naa¢laws mloung w QTY. MECHANICAL PERMIT FEE
U � Wildinmg etmatrwCJaq std hcrebyeumvnne rtprtunaures ofrhu city to rnmtt upontM SEISMIC FEE
above-
(We)
poppy fat iurnly an pupae,. PERMIT ISSUANCE
(We)agree nr ave,inJcmmfy and kap hmrnlce the Chy of Cup-nimr against ELECTRIC TEIi
liabilitin.judgrist antis"expcn%cs which may in any way acme agaimt.vid City
In anlequerce of the Rimming of Jul Pmam. ALTER OR ADD TO MECH. PLUMBING FEE
APPLICA"YDBRSTANDSANDWII COSIPLYWRHALLNO POINT AIR HANDLING UNIT UP0 Iggp CFM)
SOURCL nC PATI -� / MECHANICALME
GAIR HANDLING UNIT(OVFR IB,"UND CONSTRUCDONTAX
. tcol AppmanVComramar Dun ELKHAUSTHOOD(WNULT) HOUSING MITIGATION HX
MATERIALS DISCLOSURE
Will Jet epplianv orfumme building ncmnpnt awe or hem/e,heruJaus comeriel HEATING UNIT(TO 100.000 BTU)
as deftN by the Copnim)Muacilwl Co ia,Clmpttt 9.11,and the Hma on end Safety
Code,Section 25531(.)? HEATING UNIT(OVER[W."BTU)
0ya nNo VENTILATION FAN(SINGLE RESEED PAID
Will me aMiw t or fuwm W ilding wcupaot u cyuipnent m devices which Dam RacipY
room haaardwa air rnnmmivnu u lefmM by the Bay Area Air Quality Msmmgcri BOILER-COMP OHP OR 100.0f0 BTU)
a^ TOTAL:
Diltd
F1 Yes E:]No HOIL17R-COM P(OVER I W,"BTU)
I hose red the hawrLws materialsrecryirtmrnu umvltt CTe perfi 95 of mh,Csi- AIRCONDCHONER ISSUANCEI
Amin Ihalth&Sdny Ca v.S.clans 259M 11.131 ant]25534.1 andmrnnd Jut if not NEW RESIDENTIAL SUCH. SQ.FT.
beiui sekso m constantly have.rvanm.Jotim is my reapwibilitym miry Ne occopn
M the omairermu wNch must be urn Priormo i.smaecc ire Ccnifeuc of Ocnmpancy.
(TvneraauJwnrel.seat Due TOTAL I ISSUED BY:
OFFICE